A 219-page report released yesterday made 40 recommendations in a broad assessment of health issues which affect an estimated 20% of New Zealanders each year, and 50%-80% of people at least once in their lifetime.

David Clark

''We think New Zealand's future mental health and addiction system should build on the foundations in place, but should look and be very different,'' the report said.

''At its heart should be a vision of mental health and wellbeing for all ... hospital and inpatient units will not be the centre of the system.

''Instead, the community will be central, with a full raft of intervention and respite options designed to intervene early, keep people safe and avoid inpatient treatment where possible.''

The inquiry, led by former health and disability commissioner Ron Paterson, was the sixth general inquiry into mental health policy and services in New Zealand since 1858.

It received 5200 submissions and held 400 meetings and 26 public forums.

The result has been a sweep across the fields of mental distress, mental disorder and addiction which makes bold recommendations in some areas - such as repealing the Mental Health Act, tightening alcohol regulations and proposing a treatment-based rather than penal approach to drug offences.

Some recommendations are controversial, such as setting a targets for reduction in suicides - a 20% drop by 2030 - and to measure the effectiveness of mental health and addiction services.

In other areas the report held back, such as the role of ACC, whether or when a new mental health and wellbeing strategy should be developed, which agencies should lead what work, and the amount of funding which should be put in each area.

''We have explicitly avoided developing another strategy or a shopping list of activities, or short-term investments,'' the report said.

''We do not want to dilute attention from the most important things necessary to create the right environment to support a significant shift over time in how we prevent and respond to mental health and addiction challenges.''

The report acknowledged the Government had also commissioned an inquiry into the health sector as a whole, and urged that mental health be placed at the forefront of thinking regarding primary health care.

''New Zealand's mental health and addiction problems cannot be fixed by Government alone, nor solely by the health system,'' the report said.

''We can't medicate or treat our way out of the epidemic of mental distress and addiction affecting all layers of our society.

''We need to ensure practical help and support in the community are available when people need it, and government has a key role to play here.

''But some solutions lie in our own hands. We can do more to help each other,'' the report said.

New Zealand's approach to drugs needed to change, the report said.

''While New Zealand was the first country to introduce a state-sponsored needle exchange programme, we seem to have lost our spirit and failed to put people's health at the centre of our approach.''

It was similarly forceful on the place of alcohol in society.

''We do not believe one in five New Zealanders drinking hazardously each year is a small minority,'' it said.

''We also know that alcohol's reach across society is far greater than simply the sum of its impacts on individual drinkers; families, friends and communities are all touched through one person's drinking ''

Health Minister David Clark said it would take the Government some time to work through the report and do justice to its recommendations.

''We've already identified mental health and wellbeing as a priority for the next Budget. We'll be working through the detail on that, informed by the report.

''We're working through the report's 40 recommendations already, and the Government will respond formally in March next year.

''I want to be upfront with the public, though, that while some things can be addressed in relatively short order, many of the issues we are facing, such as workforce shortages - while we're moving on them now - will take many years to fully address.''

Key recommendations

• Repeal and replace the Mental Health Act.• Review laws and regulations concerning drug possession and sale of alcohol.• Set a target of a 20% reduction in suicide rates by 2030.• Establish a suicide prevention office.• Establish a new Mental Health and Wellbeing Commission.• Significantly increase access to mental health and addiction services.• Make improving mental health a specific focus of the primary healthcare system.• Strengthen the consumer voice in developing mental health and addiction programmes.• Make families more involved in treatment.• Improve training and retention of mental health and addiction workers.